Provider Demographics
NPI:1851550578
Name:JOEL R. BINGHAM, DDS, PC (DBA: PREMIER DENTAL CARE)
Entity Type:Organization
Organization Name:JOEL R. BINGHAM, DDS, PC (DBA: PREMIER DENTAL CARE)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-466-6161
Mailing Address - Street 1:801 S RISING SUN DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6009
Mailing Address - Country:US
Mailing Address - Phone:208-466-6161
Mailing Address - Fax:208-298-0633
Practice Address - Street 1:801 S RISING SUN DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6009
Practice Address - Country:US
Practice Address - Phone:208-466-6161
Practice Address - Fax:208-298-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty